Fees at our Consulting Rooms
Surgical Consulting Fees
BallaratOSM will charge a fee for your time discussing your condition with your surgeon. This is not covered by private health insurance, which contributes towards hospital based treatment. Our fees reflect the AMA fee structure. Payments can be made at our clinic via EFTPOS, VISA or MASTERCARD. We can help you claim any Medicare rebate to be paid directly into your account. Fees for surgery are seperate (see below). Most surgical procedures includes consultations for about six weeks afterwards.
Standard consultation fee: $175 – payable on the day (Medicare rebate of $72.75 is claimable).
Second opinion fee: $300 – payable on the day (Medicare rebate of $72.75 is claimable).
This fee is only used where major surgery has been recently undertaken.
Review appointment fee: $90 – payable on the day (Medicare rebate of $36.55)
Telemedicine fees for Orthopaedic Consultations during COVID-19
These fees are based on the fees above. The rules have recently changed and associated with Medicare rebates changes on a weekly basis during the COVID pandemic. You can get a Medicare Rebate for a Telephone or Video conference with your surgeon (as above). We bulk bill the following patients:
- Health care card holders
- patients required to self-isolate or self-quarantine
- patients 70 years or older
- Aboriginal or Torres Strait Islander descent—is at least 50 years old; or
- pregnant patients
- the parent of a child aged under 12 months
- patients being treated for a chronic health condition
- immune compromised patients
- have suspected COVID-19 infection.
Note:the Sports Medicine Registrar routinely bulk bills, and may save you from needing to speak directly to the surgeon.
Sports Medicine Fees
Fees for consultations with our Sports Physician are the same as for surgical appointments, i.e. $175 initial consultations, $90 review. If this is in the rooms, and you have a referral, medicare rebates are also the same ($72.75 initial, $36.55 review)
If you don’t have a referral from your GP, you have two options:
1. You can still see our Sports Physician, but your medicare rebate will be less ($38 initial, $21 review), or
2. You can see our Sports Medicine Registrar, and your initial appointment will be no more than $50 out of pocket ( not including any equipment/braces/splints etc).
Telemedicine fees for Sports Medicine are also the same, except all telemedicine consultations with our registrar will be bulk-billed.
Our surgical costs are based around the Australian Medical Association (AMA) fee schedules. You and your surgeon will discuss the anticipated surgical costs. Private health insurance doesn’t mean no out of pocket expenses – but we are committed to help you understand these expenses.
Other costs to budget for include the Hospital, the Anaesthetist, a Physician if involved, the Surgical Assistant, Pathology, Radiology, Physiotherapy, and sometimes others. The range of fees depend on your insurance policy, but we find many insurers talk of “Gap Cover” which doesn’t cover the AMA fee.
Check your policy allows private hospital treatment, and doesn’t exclude certain treatments such as joint replacements. We find insurers talk of “Gap Cover” however this means vastly different things with different insurance companies.
You may need to pay gaps to the hospital, anaesthetist, assistant surgeon, and surgeon totalling between $800 and $4000 for standard treatments. Our administrative team will check your insurance policy while organising your admission to ensure no surprises.
Not all insurance policies cover Private Hospitals. We do not have the same access to beds & operating lists in Public Hospitals as we comply with the principle of “Treat In Turn”. In Public Hospitals, we are obliged to treat patients in the order they are put on the waiting list for surgery.
There is still an advantage to patients being private rather than public patients.
- you can choose your surgeon, who is then responsible and should be aware of all decisions
- your avoid the wait to be seen in outpatients (which is the biggest single problem in public health)
- your followup treatment is with your surgeon in our rooms
Out of pocket expenses may apply, as above, but may be less if the hospital chooses not to ask for your “excess” payment. Because of the limitation of this resource, we do not advocate patients with full insurance using this option. St John of God carries advantages including a predominance of single rooms, and Ultra Clean Ventilation in the operating theatres. Some patients with this lower level of insurance still choose surgery at St John of God, and accept higher hospital expenses.
Firstly, don’t take a financial risk, assumptions that surgery will allow you to return to the workforce are sometimes wrong. All Surgeons at Ballarat Orthopaedics have a public appointment at Ballarat Base Hospital, where free treatment is available. Should you wish to pursue free treatment, please ask your GP to refer you to Ballarat Health Services Outpatients Department.
Our private practice, including our private consulting rooms, is for patients paying a fee for services delivered. Consulting fees don’t cover our costs, so we do not see uninsured patient with a view to putting their name on the public hospital waiting list. We are happy to see uninsured patients if they are seeking private surgical treatment at the hospitals we attend.
To understand the cost of surgical treatment – it is important to understand the surgeon’s fee is only a small part. Other costs include the hospital, any surgical implants (eg knee replacement), anaesthetists, assistant, radiology, and pathology.
Your total cost (not just the surgeon) AFTER Medicare could approximate:
Knee arthroscopy (eg cartilage operation) – $3,700
Knee cruciate ligament reconstruction – $5,200*
Shoulder surgery (cuff tear or instability) – $7,000*
Hip or Knee replacement – $17 000
* Physiotherapy not included in this figure.
It may be possible to have a small saving by having private surgery in a public hospital, but the financial benefit is very small. The majority of our patients are able to walk and be back home within a day or so of joint replacement surgery. Private uninsured patients having treatment in a hospital are required to pay for implants and other expenses PRIOR to admission.
All information here is given as true and correct as of the date of publication (June 2017). If you have any queries, please contact our clinic.
What is junk insurance?
Junk health insurance is a term used to describe a health fund policy or plan that has so many exclusions, it is virtually useless in a private hospital setting. Many patients only realise that they have junk insurance after being advised by their doctor that they need urgent medical treatment which may include surgery. As this graph below shows, the number of health insurance policies with exclusions has risen significantly over the last 10 years.
Proportion of policies with exclusions and insured persons covered, 2004 to 2016 Ref: APHA Information Paper, Private Health Insurance March Quarter 2016, p.11
What to do
- Obtain a copy of your health insurance policy and write down everything you are not covered for (exclusions).
- If you are unhappy with your health fund exclusions, you can change private health insurance funds or upgrade your cover with existing funds, but beware of any restrictions for pre-existing health conditions.
- Some patients choose to have an excess rather than exclusions in their health insurance cover. What is important is to know exactly what you are covered for before you need to use it.
For further information, see www.privatehealth.gov.au
Payment on the day of appointments and payment prior to surgery of any out of pocket expenses is expected.
We don’t handle cash – as there are so many other better options!
We accept any of the following Payment options:
- Direct deposit
- Visa or Mastercard
Have Other Questions?
If we have not answered your question well enough on this page or if you have a question which is not covered please get in contact with your doctor.